Coronavirus cases and hospitalizations are rising across the country, health officials are voicing caution, warning that although there is an increase in the pace of vaccinations, the nation may have to prepare for a fourth wave of COVID-19 infections, if Americans relax their guards too rapidly.
Since 71.8% of Americans 65 and older inoculated have been given at least one dose of a coronavirus vaccine, a fourth wave could have fewer hospitalizations and deaths, according to experts.
“We have to begin to re-think how COVID case data is interpreted,” said Dr. John Brownstein, chief innovation officer at Boston Children’s Hospital and an ABC News contributor. “With rapid dissemination of the vaccines, increases in cases among healthy populations will not necessarily translate to hospitalizations and deaths as previously seen during the pandemic.”
At a White House briefing earlier this week, Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention (CDC), said that she is concerned the U.S. could see “another avoidable surge” in COVID-19 cases if protective measures are ignored or relaxed. These measures include testing, mask-wearing, social distancing, hand-washing and avoiding crowds.
On Saturday, Dr. Anthony Fauci, the nation’s top infectious disease expert, told ABC News’ “Good Morning America” that he is “quite concerned” that “we might start seeing a resurgence of cases.”
After two months of steady declines, in the last week the national case average has increased by 12.5%, with just over 60,000 cases a day, similar to the case number increases experienced during the summer surge.
“We’re seeing rising cases in several locations around the world, including in some U.S. states so a fourth wave seems possible,” Rachel Baker, an epidemiologist at Princeton University, told ABC News.
In the first wave, the U.S. recorded a rapid rise in cases and deaths, concentrated in the Northeast, and more specifically, New York. During the summer, the country experienced a second wave with an increase of cases, hospitalizations and deaths throughout the nation. In early fall, the nation’s COVID-19 numbers fell, but were followed by an intense third wave in the late fall and early winter months with an unprecedented surge of cases, hospitalizations and deaths.
A seven-day case average jump by at least 10% in the last week, hase been observed in 22 states according to data collected by the Department of Health and Human Services, and the number of patients hospitalized appears to have also stopped falling, plateauing around 33,000, after falling by more than 70% since early January.
Testing is declining, although the tests being completed show a rise in COVID. The average number of tests has decreased by 12.2% nationally, while the average test positivity increased from 4.2% to 4.8%. With less tests, fewer cases are being discovered, leaving the possibility that states are missing potential community spread.
“I worry that we have plateaued, as we lose ground against emerging variants and increase transmission by reopening and relaxing mitigation measures, like restrictions on indoor activities,” Neil J. Sehgal, assistant professor of health policy and management at the University of Maryland School of Public Health, told ABC News.
Cases rising despite more vaccines being administered
More seniors are getting vaccinated, but many health officials across the country are citing increasing infections among young people as the possible reason for rising case rates.
In Massachusetts, where cases have been rising steadily, residents 29 and under account for more than 45% of the state’s positive COVID-19 tests over the last two weeks.
Earlier this week, Chicago’s public health commissioner, Dr. Allison Arwady, also warned that the city’s rising test positivity rate is being pushed up by increasing cases among younger adults ages 18 to 29.
“I am concerned, and I hope everybody is concerned when they look at this data,” Arwady said.
And in Michigan, children ages 10-19 now have the highest COVID-19 case rate, which “is increasing faster than that of other age groups,” said Dr. Sarah Lyon-Callo, director of the MDHHS Bureau of Epidemiology and Population Health.
The American Academy of Pediatrics and the Children’s Hospital Association reported this week a slight increase in cases was reported last week, after a steady decline in child cases over the past two months.
Experts suggest the rise may be related to the emergence of more contagious coronavirus strains, or variants. “Increasingly, states are seeing a growing proportion of their COVID-19 cases attributed to variants,” Walensky said on Monday.
Although the U.S. is still sequencing very few COVID-19 cases, over 8,300 cases of the variant first found in the U.K., B.1.1.7, has now been discovered in all 50 states. According to the CDC, Michigan currently ranks second in the nation for the most reported cases of the B.1.1.7 variant, with under 1,000 confirmed cases.
Despite the increase in cases, dozens of states have moved to reopen, with governors relaxing restrictions on many businesses like restaurants and gyms. With millions of young Americans traveling for spring break, there are concerns that the virus could spread further and be brought to other states when travelers return home.
Experts say with many of the most at-risk Americans dosed, this potential wave may not be as lethal or significant as previous ones.
“With a large proportion of the vulnerable individuals now vaccinated, that fourth wave in cases may not translate into a fourth wave in deaths,” Baker said.
Even if a fourth wave is “likely,” Sehgal said, “I don’t think it will be anywhere near the magnitude of the wave like we saw after the winter holidays, nor as deadly.”
4th wave may be controlled by Vaccination expansion
Further expansion of vaccinations can play a key role in controlling a potential fourth wave. The CDC reports, as of Saturday, 27.6% of the total U.S. population has received at least one dose of a coronavirus vaccine, and 15.1% of the population is fully vaccinated.
Forty-seven states and Washington, D.C. have either already expanded vaccine eligibility to all residents over the age of 16 or have announced plans to do so in the coming weeks, in alignment with President Joe Biden’s May 1 eligibility deadline.
“I am encouraged by the rate of vaccination — even in my most optimistic moments I didn’t expect we’d be averaging nearly 2.5 million doses per day, and protecting the most vulnerable means that fewer new cases will result in hospitalizations and deaths as compared to earlier surges,” Sehgal said.
However, there are still segments of the population that are awaiting inoculation. Not all seniors have been vaccinated, and there are Americans with preexisting health conditions who are at risk of severe illness, but are not yet eligible for a shot.
“We still have vulnerable segments of our population across all age groups that have yet to be vaccinated. While this surge may not be at the same scale, the rise of B.1.1.7 and rapid reopening, we will contribute to avoidable hospitalizations and deaths,” Brownstein said.
“Any uptick in cases means more worry for those groups,” added Sehgal.
And while these vaccines do offer protection against the new variants, “for the unvaccinated this may represent a higher risk. Time and time again, we find that the risk of future outbreaks is really tied to the strength of control measures we have in place,” Baker said. “In regions of the U.S. with lower vaccination coverage, stepping back from social distancing measures too quickly will elevate the likelihood of a fourth wave.”
In conclusion, although states are lifting their protocols with mask wearing and social distancing, and more people are getting vaccinated, it is in fact the responsibility of each individual to maintain those protective guidelines that have been in place since spring of 2020 to help prevent a fourth surge. Personal responsibility can collectively make a difference.